The Association of Unconventional Natural Gas Development with Adolescent Internalizing Disorders

摘要 自2000年以来，非常规天然气开发（UNGD）急剧扩大， 化学、物理和心理社会危害以及更普遍的社区影响。虽然全球发展司 十多年来，性别问题一直是公众关注的问题，但迄今没有任何研究对性别问题司与 青少年的心理健康结果，尽管认识到儿童可能是最脆弱的 人口对环境暴露的不利影响。识别与抑郁症相关的因素 焦虑是非常重要的，因为这些疾病可能导致残疾，降低生活质量， 需要大量的临床护理和公共卫生支出。先前的研究涉及两个主要途径 联合国全球发展司的活动、空气质量和压力都可能影响儿童的心理健康。我 因此，有一种假设认为，联合国全球发展司活动有助于增加新发病内在化的可能性， 青少年的疾病。我们建议使用电子健康记录（EHR）来测试这一假设。 宾夕法尼亚州的盖辛格卫生系统，进行了一项流行病学研究， 联合国全球发展司活动（使用纳入空间和时间的现有指标， 关于UNGD的信息，按井期、规模、天然气产量和患者居住地划分），以及新发病例 内化疾病，使用诊断代码和药物顺序的组合对我们的结果进行分类， 在大约35000名青少年中。对于我的子目标，分析将指向效果 这种联系的改变，特别是按性别、接受医疗援助、处方 抗抑郁药和住宅绿化我的第二个目标是审查联合国全球发展司与 在大约28，000名青少年中，使用患者健康评分， 测试仪（PHQ-9）。使用PHQ-9数据将使我们能够评估更广泛的短期 抑郁症状具有更高的敏感性，而诊断和药物订单将确定更严重 焦虑和抑郁障碍具有较高的特异性。在子目标中，我将评估协会是否 当联合国全球发展司的活动指标仅限于钻井和水力压裂阶段时， （因为报告的卡车交通量较高），如果将评估的症状限制在 关于睡眠和注意力。拟议的研究将首先调查全球发展司在下列领域的活动： 与青少年心理健康的关系。通过利用EHR数据与大样本量在一个地区广泛 联合国全球发展司的活动，这些研究可以提高对联合国全球发展司潜在健康影响的认识。 通过全面的培训计划和密切的指导，PI将接受以下主题领域的培训： 青少年心理健康，环境流行病学分析方法的使用，以及 向政策利益攸关方提供研究结果。因此，该项目将有助于PI的长期目标， 环境流行病学研究的职业生涯，以告知循证健康政策。

ABSTRACT Unconventional natural gas development (UNGD) has dramatically expanded since 2000 along with its chemical, physical, and psychosocial hazards as well as more general community impacts. While UNGD has been of public concern for over a decade, no study yet has evaluated the relationship between UNGD and mental health outcomes in adolescents, despite the recognition that children may be the most vulnerable population for the adverse effects of environmental exposures. Identifying factors associated with depression and anxiety is of high importance because these disorders can lead to disability, decrease quality of life, and require high expenditures for clinical care and public health. Prior research implicates two primary pathways from UNGD activity, air quality and stress, both of which can impact the mental health of children. My hypothesis is therefore that UNGD activity is contributing to increased odds of new onset internalizing disorders in adolescents. We propose to test this hypothesis using electronic health records (EHRs) from the Geisinger health system in Pennsylvania, conducting an epidemiologic study of the association between UNGD activity (assigned individually to patients using existing metrics which incorporate spatial and temporal information on UNGD by well phase, size, and gas production, and the patient’s residence), and new onset internalizing disorders, classifying our outcome using combinations of diagnosis codes and medication orders, in an adolescent population of approximately 35,000. For my sub-aims, analysis will be directed toward effect modification of this association, specifically by sex, receipt of Medical Assistance, prescription of antidepressants, and residential greenness. My second aim proposes to examine the association of UNGD activity with depressive symptoms among approximately 28,000 adolescents, using scores from Patient Health Questionnaires (PHQ-9). Using PHQ-9 data will enable us to evaluate a broader range of shorter-term depressive symptoms with higher sensitivity, while diagnoses and medication orders will identify more severe anxiety and depression disorders with higher specificity. In sub-aims, I will assess if the association strengthens when the UNGD activity metric is limited to specifically the drilling and hydraulic fracturing phases (because of higher reported truck traffic) and if it strengthens when limiting the symptoms evaluated to those regarding sleep and concentration. The proposed studies will be the first to investigate UNGD activity in relation to adolescent mental health. By utilizing EHR data with a large sample size in a region with extensive UNGD activity, these studies can advance the state of knowledge on potential health impacts of UNGD. Through a comprehensive training plan and close mentorship, the PI will receive training in the subject area of adolescent mental health, the use of analytic methods for environmental epidemiology, and the communication of research findings to policy stakeholders. Thus, this project will contribute to the PI’s long-term goal of a career in environmental epidemiologic research to inform evidence-based policies for health.